People at the centre of health & care
National Person-Centred Health & Care Programme
Care Experience Breakout Sessions
Trudi Marshall
Nurse Consultant Older People
NHS Lanarkshire
Older Person’s Pathway
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What is Frailty?
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What is Frailty?
• State of high vulnerability for adverse health outcomes, including
disability, dependency, falls, need for long-term care, and mortality.
• Commonly used to describe older persons at increased risk for
morbidity and mortality.
• Typically involves alteration in multiple, not individual, body systems.
• Syndrome associated with reduced functional reserve, impairment in
multiple physiological systems, and reduced ability to regain
physiological homeostasis.
(Fried, Ferrucci, Darer, Williamson, & Anderson, 2004. Morley, Kim,
Haren, Kevorkian, & Banks, 2005. Bartali et al., 2006)
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Why is Frailty Important ?
• Caring for frail older adults is difficult and challenging because they
have an increased burden of symptoms, are medically complex, and
often have increased social needs. (Espinoza & Walston, 2005)
• Frailty is a strong predictor of several negative outcomes including
disabilities, institutionalization, and mortality. (van Iersel & Rikkert,
2006) Frailty has also been linked to acute illness, falls, and
increased vulnerability. (Espinoza & Walston, 2005)
• The identification of frailty in its early stage is important because
interventions may potentially prevent, or delay the clinical
consequences of frailty. (Bartali et al., 2006)
Screening for frailty and assessing levels of frailty in older adults can
identify those most vulnerable and assist in targeting nursing
interventions.
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Comprehensive Geriatric Assessment (CGA)
Social Circumstances
informal support available from family
or friends
social network such a visitors or
daytime activities
eligibility for being offered care
resources
Medical
Mental Health
• co morbid conditions and disease
severity
• medication review
• nutritional status
• problem list
• cognition
• mood and anxiety fears
Environmental
Functioning
• home comfort, facilities and safety
• use or potential use of telehealth
technology etc
• transport facilities
• accessibility to local resources
• basic activities of daily living
• gait and balance
• activity/exercise status
• instrumental activities of daily living
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People at the centre of health and care
•Well established MDT
approach
•In depth MDT assessment
•Recognition of frailty
•Discharge planning
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•ACE Nurse
•Screening - signposting
•CGA
•AMT, functioning, social,
urinalysis, L+S BP, Falls history,
Meds reconciliation
•Supporting discharges
Getting the assessment of older people
right in the AMU has the potential to
improve outcomes, reduce inappropriate
hospitalisation, and potentially reduce the
need for long-term care. (RCP, 2012)
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Impact
• Over 85% of frail older people reaching
speciality beds within 24 hours (prev 40-60%)
• All patients who require L&S are now having
this assessment undertaken (prev 5%).
• Over 90% of AMT’s are now being completed
(prev >5%)
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Impact
• Reducing the average length of stay of emergency or
unplanned admissions
• Reducing emergency inpatient bed days for people
over the age of 65years
• Improving the quality of the patient care experience
• Supporting the increase in the level of older people
with complex care needs receiving care at home
• Supporting “Shifting the Balance of Care”
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Staff feedback
• “The nurse post in the emergency receiving unit makes a big
difference to thorough assessment and early intervention for
older people, we feel more informed and more in control of
the acute care group.” (Consultant Geriatrician).
• “The nurse often finds out from carers/ relatives which
community pharmacy the patient uses and if they use a
compliance aid. This is vital knowledge for discharge and
allows the ward pharmacists to contact the community
pharmacist on discharge and communicate changes made.
They also identify patients who are having difficulties which
allows me time to resolve these problems which were
previously often only identified on discharge.” (Pharmacist)
People at the centre of health and care